Healthcare Provider Details

I. General information

NPI: 1992706022
Provider Name (Legal Business Name): DENISE L SQUIRE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 01/09/2024
Certification Date: 01/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

556 FIRE STATION RD
CLARKSVILLE TN
37043-4072
US

IV. Provider business mailing address

720 RIVER BEND DR
CLARKSVILLE TN
37043-5349
US

V. Phone/Fax

Practice location:
  • Phone: 931-553-8500
  • Fax:
Mailing address:
  • Phone: 931-553-8500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1062
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberP2410
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: